Dr. Kumanyika said topic areas that do not neatly fit into current organizational structure could present opportunities to stimulate cross-fertilization and integrative approaches that are consistent with the framework. This might create certain economies, since some of the same determinants lead to several risk factors and diseases. Another member strongly agreed and said it would be a shame if the Committee did not push for ways to get determinants integrated across each of the topic areas. Dr. Fielding proposed that every topic area should have a brief section on disparities. This would not necessarily negate the need for a separate topic area specifically devoted to disparities. He asked if any members disagreed with that idea. No Committee members voiced disagreement. Dr. Fielding said this would be one of their recommendations.
Dr. Fielding said that disability, infrastructure, and some other issues have not gotten enough attention. Some of the topic areas could be split, such as nutrition and overweight, substance abuse, and injury (unintentional vs. intentional). Access to services could be split between access and quality. He clarified that these were the areas that the Committee previously voted to retain, but additional categories were also recommended by participants. He said that the Committee may need to go back to knowledgeable groups to discuss these. Dr. Fielding suggested that the Subcommittee on Topic Areas should do a final revision of the list. They could then poll Committee members for word-smithing, apply the selection criteria to the list, and finalize it before the April 20th meeting. Ms. Blakey said this proposed timeline would work well.
Dr. Fielding said that the Committee should probably not suggest a separate workgroup be convened for each topic area, since some topics are closely aligned. A single workgroup could address multiple topic areas. He noted that this would ultimately be a managerial decision. Dr. Kumanyika pointed out that, as the Committee finalizes its proposed topic areas, members should look at whether prevention approaches are isolated from secondary and tertiary prevention. She said that a lot of the diseases have objectives that start with the disease, and the user would have to go to a completely different section to look at how to prevent it.
VI. Other Subcommittee Efforts
Subcommittee on System Specifications
Dr. Manderscheid, Chair of the Subcommittee on System Specifications, explained revisions that his group made to its final report after presenting it at the last meeting. These included: 1) adding an example of an intervention that has an impact on health determinants, and 2) adding an overall cost estimate. Dr. Kumanyika asked if there were any questions or comments. None were raised. She called for a vote to approve the final report. All Committee members who were present voted in favor of approving the document.
The revised report of the Subcommittee on System Specifications is approved.
Subcommittee on Implementation
Dr. Kumanyika asked for an update on the activities of this subcommittee. Since Eva Moya, Subcommittee Co-Chair, was not on the call, she asked Adewale Troutman, Subcommittee Co-Chair, to provide an update. He explained that he had had to leave the first call early, and the second call was rescheduled. NORC staff explained that the work of this subcommittee is a very early stage. They have been discussing which external members should be invited to participate and have been defining whether the term “implementation” focuses on programs and policies, or processes. The next step for the subcommittee would be to discuss implementation tools.
Subcommittee on Priorities
Dr. King, Subcommittee Co-Chair, reported that the members held a conference call. She said that they are seeking to describe a system of priority-setting at all levels of government, adding that a process for national priority setting needs to be built up from state- and local-levels. Dr. King also said that there was strong support for using preventable burden as a criterion for prioritization.
Subcommittee on Data and IT
Dr. Manderscheid, Subcommittee Chair, said that the subcommittee had their first meeting a week ago. They focused on support for data and how to coordinate with other agencies to obtain data on determinants. The subcommittee organized data into three categories: epidemiological data, services data, and encounter costs data. The group plans to produce high-level recommendations for things that need to be done to strengthen the relevant Federal data systems.
VII. Next Steps
Dr. Fielding commented that the Committee was hopeful and awaiting the confirmation of Governor Sebelius, HHS Secretary Designate. He asked if ODPHP would authorize the Committee Chair and Vice-Chair to send Governor Sebelius a letter to congratulate her on her appointment. He asked if there were any objections among members of the Committee to this approach. No Committee members voiced objections to this idea. RADM Slade-Sawyer thanked the Committee for their productive discussion.
Dr. Fielding asked whether expanding the number of topic areas to almost double what it was would be feasible from a Federal perspective. RADM Slade-Sawyer was not able to provide an answer this question, but explained that Federal personnel who will manage the Healthy People 2020 topic areas will take on this responsibility in addition to their other duties. Therefore, it is critical to have strong buy-in from them.
Dr. Fielding asked if there are logical groups within HHS that can take responsibility for cross-cutting topic areas such as social determinants. Ms. Blakey replied that the Centers for Disease Control and Prevention (CDC) had previously suggested social determinants as a topic area and is taking the lead in reaching out to other agencies to co-lead that topic area. Dr. Fielding suggested that people outside of government be involved as well, and Ms. Blakey responded that the Healthy People Consortium could be helpful in that respect. She suggested that interested organizations that were listening to the meeting on the telephone contact ODPHP directly about becoming involved.
ODPHP staff asked if the Committee was interested in holding an in-person meeting in June. Dr. Fielding said that the Committee should have an in-person meeting, but that his schedule for June was full. He and Dr. Kumanyika agreed to work with ODPHP to identify appropriate dates for an in-person meeting. After a brief discussion of the timing of the meeting in relation the potential for progress on health reform in the fall, Dr. Fielding said that the group will look for opportunities. He asked that NORC provide help in developing talking points on the relevance of Healthy People 2020 to health reform.